Individual
FRED MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4044 W HADLEY ST, PHOENIX, AZ 85009-5310
(602) 272-1213
Mailing address
4044 W HADLEY ST, PHOENIX, AZ 85009-5310
(602) 272-1213
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3856
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AHCCCS
729725
AZ
Enumeration date
11/20/2006
Last updated
07/08/2007
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